Real-world evaluation of utilisation patterns of lipid-lowering therapies (LLTs) and quality of lipid control in Kuwait : a national multi-study project

Alsaffar, Noor Ahmad Jassim

Thesis

Real-world evaluation of utilisation patterns of lipid-lowering therapies (LLTs) and quality of lipid control in Kuwait : a national multi-study project

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Creator

Alsaffar, Noor Ahmad Jassim

Rights statement

Strathclyde Thesis Copyright

Awarding institution

University of Strathclyde

Date of award

2026

Thesis identifier

T17988

Person Identifier (Local)

202187477

Qualification Level

Doctoral (Postgraduate)

Qualification Name

Doctor of Philosophy (PhD)

Department, School or Faculty

Strathclyde Institute of Pharmacy and Biomedical Sciences

Abstract

Introduction: Lipid-lowering therapies (LLTs), including statins and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is), are used to manage elevated low-density lipoprotein cholesterol (LDL-C). Over time, LLT prescribing patterns have been shaped by evolving guidelines. However, national data on LLT utilisation patterns and the quality of lipid control in Kuwait remain unknown. Methods: This thesis comprised three nationwide quantitative studies conducted across healthcare settings governed by the Ministry of Health in Kuwait. First, a retrospective, repeated cross-sectional study utilising data from the Central Medical Store (CMS) was conducted to quantify utilisation trends of LLTs over an 11-year period (2012–2022). Second, a nationwide, cross-sectional design among patients attending primary healthcare centres (PHCCs) was employed to evaluate LLT prescribing patterns and assess the extent of lipid control. Third, a retrospective cohort study utilising routinely collected dispensing data from a tertiary cardiac care centre was performed to evaluate the real-world effectiveness of PCSK9is between 2016 and 2022. All data were analysed using descriptive statistics and regression methods, as appropriate. Results: At the national level, findings from the CMS data demonstrated a significant overall increase in both utilisation and expenditure trends of LLTs. Utilisation, measured by number of supplied units per thousand inhabitants per year, rose by 52% (n= 71,839), from 138,549 in 2012 to 210,388 in 2022, while defined daily doses per thousand inhabitants per day increased by 119% (n= 62.2), from 52.4 in 2012 to 114.6 in 2022. Statins accounted for the increase in utilisation. At the PHCC level, findings from the cross-sectional study showed that most patients were prescribed statins (98.8%, n= 429/434). Lipid control was suboptimal, with only 20.4% (n= 65/318) achieving LDL-C targets across all cardiovascular (CV) risk categories. At the tertiary care level, the real-world effectiveness study showed that PCSK9is significantly reduced LDL-C levels (n=104) by 41.9% (95% CI: -50.9% to -24.1%, p<0.001). Conclusion: The utilisation and expenditure of LLTsin Kuwait have increased substantially. Statins remain the cornerstone of treatment, reflecting their continued role as first-line therapy. Despite the widespread use of statins in PHCCs, lipid control remains suboptimal, particularly among patients at extreme CV risk. PCSK9is reduced LDL-C significantly (~42%) but less than in clinical trials (~60%). These findings highlight the urgent need for targeted interventions to optimise lipid management.

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